Provider Demographics
NPI:1013191840
Name:JUSAY, PAULO NARVAEZ (MSN, ACNP, APRN,BC)
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:NARVAEZ
Last Name:JUSAY
Suffix:
Gender:M
Credentials:MSN, ACNP, APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 GREENWICH DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1208
Mailing Address - Country:US
Mailing Address - Phone:714-732-8913
Mailing Address - Fax:
Practice Address - Street 1:2328 GREENWICH DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-1208
Practice Address - Country:US
Practice Address - Phone:714-732-8913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17258363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACN213ZOtherPTAN